cardiac electrophysiologist, cyclist, learner

A recent study in the Journal of the American College of Cardiology shed more light on the commonly used drug combination of aspirin and a vitamin-K antagonist (such as warfarin). It was a small registry study from one region of France but I believe it offered confirmatory evidence against this dangerous practice. Investigators followed patients […]

The ultimate goal in medicine: protect the patient from stroke. Even a heart doctor has to admit the dominance of the human brain. Always think about preventing stroke. It’s one of the worst outcomes that can happen to a person. Life as a ‘normal’ human requires a healthy brain. A stroke irreversibly kills off part […]

Yesterday afternoon, the FDA finally approved apixaban (Eliquis) for the prevention of stroke in patients with non-valvular atrial fibrillation. I use the words ‘finally approved’ because the markedly positive ARISTOTLE trial was published 15 months ago in the New England Journal of Medicine. The long delay was mysterious. On paper, apixaban looks to be the […]

There was a lively debate on this topic at ESC 2012. One of the strategies proposed to reduce stroke in AF involves occlusion of the sack-like structure called the left atrial appendage. Two devices are being evaluated and nearing consideration for approval. There is a great deal of debate on these devices. Here is my […]

Let’s get off cell biology and back to something I really know. Atrial fibrillation, AF ablation and blood thinners. There was an important study published today in the Journal of the American College of Cardiology concerning the use of the new blood thinner, dabigatran (Pradaxa), around the time of AF ablation. A very concise overview, […]

When it comes to the risk of stroke in atrial fibrillation, it pays to be a boy. Sorry, ladies. An important question came up on my recent post on AF and stroke. Why does being female give you an automatic point on CHADS2-VASc? I keep seeing it, but I don’t see why that is. It […]

I recently came across a very important blog post on the use of the novel new blood-thinner, dabigatran (Pradaxa). Fellow Kentucky cardiologist, and frequent TheHeart.org contributor, Dr. Melissa Walton-Shirley wrote this very detailed case presentation involving a cantankerous non-compliant rural patient with AF (atrial fibrillation) that sustained a stroke while “taking” dabigatran. Dr. Walton-Shirley details […]

The unrelenting epidemic of inactivity and excessive eating wreaks havoc on more than just the heart and blood vessels. Lugging around extra weight also breaks down the joints and back. For evidence, look no further than the waiting room of any orthopedist; the people waiting for joint replacements look the same as those waiting to […]

My iPhone vibrated with an urgent message that read: Please call…The INR on your atrial fibrillation patient scheduled for cardioversion is too low. He is on that new blood thinner, Pradaxa. What do you want to do?” I responded, sounding like an expert: “It’s Ok. Pradaxa thins the blood adequately, it just doesn’t change the […]

I loved my old status. Perhaps, reveled in it would be a better description. I was a crotchety generic-medicine only doctor.** Sadly, my status changed today. Dabigatran (Pradaxa) was the culprit. It was a little nerve-racking. I wrote the order, looked at it, thought it out again, talking to myself, “John, are you sure you […]

The dabigatran party isn’t even cleaned-up yet, when another warfarin competitor has hit the press wires. As reported on Cardiobrief from a Bayer press release, Rivaroxaban (Xarelto) was as effective as warfarin in stroke prevention in patients’ with AF. A composite of major and minor bleeding events were also similar to warfarin. Rivaroxaban is a […]

John Mandrola, MD

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I am a cardiac electrophysiologist practicing in Louisville KY. I am also a husband to a palliative care doctor, a father, a bike racer, and a regular columnist at theHeart.org | Medscape